Denise Murphy, the infection control czar at Barnes-Jewish Hospital, isn't fond of the recent public scrutiny surrounding hospital-acquired infections. She particularly dislikes the scrutiny when it comes from the media.

But Murphy admits all the attention has forced hospitals to try and eliminate these expensive, life-threatening complications.

At Barnes, for example, infections that used to be written off as a necessary cost of high-level care are now the subject of long investigations. Nurses and other staff secretly report physicians who don''t wash their hands. Other established guidelines are being followed with new intensity.

Here''s one result:

Back in 2003, more than eight out of 100 women who entered Barnes-Jewish Hospital for a C-section picked up a surgical site infection while they were there. That''s down to about two out of every 100 women this year.

Hospitals across St. Louis and the nation tell a similar tale. They've tried to lower patients'' chances of acquiring an infection but know their efforts haven''t been enough.

The U.S. Centers for Disease Control estimates that one in about 20 patients — or approximately 1.7 million a year — develop various kinds of infections while in the hospital. Deaths from these infections now approach 100,000 a year. The related cost: $6 billion a year.

About 18 states, including Missouri and Illinois, now require hospitals to report some information about their infection rates. Some, including Missouri, make that information available to the public. Illinois will publish this data next year. The systems are less than perfect, but they have inspired hospitals'' improvement.

It''s partly the imperfections that aggravate Murphy. There''s a lag in the reporting. The public database only shows some types of infections in certain areas of the hospitals. And, hospitals'' varying sizes and other factors makes it tough to compare them. Here''s an example for Barnes.

A state report released last week found coronary bypass patients at Barnes were more likely to contract a surgical site infection than at other Missouri hospitals. It also found patients in Barnes'' coronary intensive care unit were more likely to contract an infection through an IV placed in a large vein than at other similarly sized Missouri hospitals.

Those findings might sound a dire warning, but they''re not the full story. In 2000, seven out of 100 patients receiving heart bypass surgery at Barnes acquired a surgical site infection after the procedure. It''s jumped between three out of 100 and one out of 100 in recent years. In 2006, the time period the state report looked at, Barnes was at the high end of that range before falling again this year.

St. John's Mercy Medical Center said its numbers were skewed by a more intensive reporting system that follows up with physicians to learn if patients reported infections after being released. Those infections accounted for about 30 percent of its total and undoubtedly made the hospital look worse compared to its peers, said Dr. Paul Hintze, Mercy''s vice president of medical affairs.

Mercy''s doing "secret shopper" programs similar to Barnes, in which undercover staff report delinquent hand washers. It''s working to always give antibiotics at the right time and follow other best practices. The hospital has even hired a company that will come in and clean certain high-risk rooms with hydrogen peroxide vapor, Hintze said.

With every improvement, hospitals find they limit infections even more. Barnes will strive toward zero next year, an ambitious, if not unattainable goal. Mercy hopes to eventually reach zero as well.

Infections once thought of as a necessary evil are now viewed as a preventable consequence.

"A lot of things we didn''t think were possible, are possible today," Murphy said.

This is at least, in part, because of pressure from a sometimes incomplete, out-of-context public reporting system.

Speaking to the virtues of transparency, U.S. Supreme Court Justice Louis Brandeis once described sunlight as the greatest of disinfectants. He never promised a perfect tan.